by Marcelo Hochman, MD
A celebration is in order! South Carolina—the state that has historically settled for incremental public policy change—just enacted the most significant healthcare reform of the year. The bill was signed into law just last month by Governor Henry McMaster.
As a practicing physician, I am thrilled that our visionary South Carolina legislators unanimously passed the most extensive Certificate of Need (CON) repeal the United States has seen in 15 years. The new legislation eliminates CON requirements for all healthcare facilities, except for nursing homes, within the next three years (and immediately for nearly 70% of regulated facilities and services). It also prohibits the economic credentialing of doctors, a recent tactic used by hospitals to herd patients to their employed physicians and facilities.
Dr. Oran Smith of Palmetto Promise Institute reported that CON researcher Dr. Matthew Mitchell of West Virginia University rated South Carolina’s reforms among the best.
“Two years ago, Montana enacted a similar reform, eliminating every CON but that for nursing homes. The difference is that Montana only regulated 9 services and technologies at the time of its reform, whereas South Carolina has one of the most extensive programs in the country, requiring a CON for 18 different services. Only New Hampshire and Florida have come close to what South Carolina just did.” – Dr. Matthew Mitchell
Putting Doctors and Patients in Charge
As an independent doctor, I have long advocated for changes that reposition doctors and patients in charge of healthcare. For that reason, I applaud the members of both South Carolina legislative chambers who put the power of choice back into the hands of patients. As a result, South Carolina has established itself as a leader in radically shifting healthcare by championing both freedom for doctors to provide the services for which they are medically qualified, and freedom for patients to choose where and from whom they receive their care. The impact this will have on the state’s economic future is profound, making South Carolina an attractive state for continued and future healthcare innovation, advancement, and investment.
Consumer choice is a cornerstone of the American economy, providing the ability to choose how and where individuals spend their money. Disappointingly, the healthcare system has moved farther from that free-market ideal, largely because of misguided regulations and contractual arrangements that have enriched “non-profit” hospital systems while limiting patients’ options for receiving care where and from whom they want.
Non-Compete Clauses in Doctor Contracts
The next step in breaking the grip that hospitals have on the health care marketplace is the elimination of non-compete agreements, which they use to prevent doctors from practicing medicine in areas near their place of employment. They serve the same purpose as CON laws—to limit competition—and produce the same result: fewer options for patients. When these non-compete agreements are removed from the equation, patients gain the ability to choose where they receive care, and physicians the ability to choose where and how to provide the services for which they are medically qualified.
Incentivize Charity Care
An additional necessary step is tax reform in the form of incentives for doctors who provide true charity care. While hospitals have avenues for government-sponsored compensation and reimbursements under the rubric of “total charity care,” a catch-all term that includes bad debt, undercompensated care, indigent care, and pro-bono care, the doctors actually providing the care receive no financial consideration. Although many doctors wish to offer care to those who cannot pay, few can absorb the costs on their own or have a place to offer it. The latter will be partially addressed by the CON repeal. Tax credits would incentivize doctors to do what most of us went into medicine for in the first place—to help our patients regardless of financial considerations.
South Carolina now stands as a trailblazer in opening the door for patients and physicians to regain health care freedom. It is truly a cause for celebration when the doctor-patient interest is bolstered over those of the incumbent systems. Bravo South Carolina!
Dr. Marcelo Hochman is a double Board-certified facial plastic and reconstructive surgeon, President of the Independent Doctors of South Carolina, Past President of the Charleston County Medical Society, and provides pro-bono care for children with vascular anomalies for which he was honored with the Order of The Palmetto, the state’s highest civilian award. He champions legislative projects to repeal the Certificate of Need law; exempting doctors from non-compete clauses as a condition of employment and enacting a tax incentive for individual doctors who provide pro-bono charitable medical care. A version of this article appeared in USA Today on May 26, 2023. Reprinted with permission.